ACL tear treatment guidelines for adolescents.

Anterior Cruciate Ligament Injuries in the Skeletally Immature Athlete: Diagnosis and Management. 
Frank, J. and Gambacorta, P. Journal of the American Academy of Orthopaedic Surgeons, 2013; 21 (2). 
http://www.jaaos.org/content/21/2/78

ACL injuries among children and adolescents start to occur more frequently compared to the past. Lack of consensus has been present in regards to diagnosis and management. For that reason, authors decided to put together a review article on the management of the ACL ruptures in active children and adolescents.
According to authors ACL tear in this group of patients requires special consideration and treatment to ensure appropriate healing and prevention of long – term complications such as: meniscal lesions, cartilage defects and early osteoarthritis development.  To avoid this, authors outline potential strategies for treating pediatric ACL injuries. 
One of the main recommendations include:

“Children should be treated by an orthopaedic surgeon who has expertise in the operative treatment of pediatric ACL injuries.
For pediatric and adolescent patients with partial ACL tears compromising less than 50 percent of the diameter of the ligament, non-surgical management, including activity modification, bracing and/or physical therapy, can be considered.
Treatment for complete ACL ruptures typically involves transphyseal ACL reconstruction surgery that partially or completely spares the femoral physis (the growth plate, contributing to 70 percent of thigh-bone growth), and adult-type surgical or arthroscopic reconstruction in adolescents at or nearing skeletal maturity.
Postoperative management may include weight-bearing and activity modifications, bracing, and a progressive physical therapy program emphasizing range of motion (ROM), closed-chain strengthening (exercises on the knee while the foot remains stationary) and a gradual and measured return to sport-specific maneuvers and activities.”

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